Laserfiche WebLink
07/18/2010 00: 03 9527586278 ADVANCED ONSITE INC PAGE 03 <br /> I <br /> i <br /> 1 <br /> . , <br /> , ' ;, Minnesota Pollution Compliance Inspection Form <br /> "'". Control Agency <br /> ��. Existing Subsurface Sewage Treatment Systems (SSTS) <br /> 520 Lafayette Road North <br /> Doc Type:Compliance and enforcement <br /> 5t Paul,MN 55155-84194 <br /> Instructions on page 6 <br /> Summary Form (Completed form must be submitted to the local unit of government within 15 days.) <br /> Parcel nurrrlaei. <br /> For Local Tracking Purposes: <br /> System status: ® Compliant ❑ Noncompliant <br /> (based on all comntinnr.P mquirements) <br /> Property Information <br /> Property owner name(s); Estate of Diana Gross (Attn: Rich Gross) Property owner phone: Rich: (612)865-8598 <br /> Property address: 55 Wear Lane North Orono, MN. 55356 _ <br /> Property owner address(if different): (Attn:Rich 721 Bridal Path Trail Hamel, MN. 55340 <br /> County: Hennepin Permitting authority: City of Orono Attn:Willy <br /> Date system constructed; 1997 Reason for inspection: Property Tranofcr <br /> System Description <br /> Brief system description: Septic Tank, Pump Chamber, and Mound Type Drain Field <br /> Local permit number: Number of bedrooms: 3 „_� Design flow rate; 450 <br /> Is the system: <br /> In Shoreland area? D Yes ® No In Wellhead Protection Area? ❑Yes it No <br /> An U.S. Environmental Protection System serving a Minnesota Deoarintent <br /> Agency(EPA)Class V Injection Well?0 Yes ® No of Heath(MDH) licensed facility? ❑Yes ® No <br /> Compliance Status(eased on state requirements additional local requirements may also apply.) <br /> Based on the information gathered and reported on attached forms, the compliance status of this system is(check one): <br /> 1$1 Certificate of Compliance—valid until (3 years from date of report); 7/12/2010 <br /> ❑ Notice of Noncompliance-For Noncompliant systems: <br /> The reason for noncompliance is: <br /> This noncompliant system is classified as (check one below): <br /> ❑ Imminent threat to public health&safety 0 Failing to protect ground water 0 Not in compliance with operating permit <br /> Certification <br /> I hereby carlify that all the necessary information hos been gathered to determine the compliance status of this system. No <br /> determination of future system performance has been nor can be made due to unknown conditions during system construction, <br /> possible abuse of the system, inad•.• ,to maintenance, or future water usage. <br /> Name: Thomas Klanchnik Certification number: R 5945 <br /> Business license name and , Advanced OnSite, Inc. L 2656 or <br /> Name of loud unit ory! -r <br /> Signature: /_ Date: July 17,2010 <br /> Required Attac dents <br /> ® Hydraulic Performance ® Tank Integrity ❑ Operating Permit Form (if applicable) <br /> El Soil Boring Logs ® Soil Separation <br /> Ei System drawing/As-built drawing 0 Any local requirements that are different from what is required on this form <br /> ❑ Other information (list): <br /> Upgrade Requirements (derived from Minn. Stat. § 115.55)An imminent threat to public health and safely(ITPHS)must be upgraded, <br /> replaced, or its use discontinued within ten months of receipt of this notice or within a shorter period If required by local ordinance.if the system is <br /> failing to protect ground water, the cy.ctem mast he upgraded, replaced,or its use discontinued within the time required by local ordinance. if an <br /> existing system is not failing es defined In law,and has at least two feet of design soil separation, then the system need not be upgraded,repaired, <br /> replaced,or its use discontinued,notwithstanding any local ordinance that is more strict. This provision does not apply to systems in shoreland <br /> areas, Wellhead Protection Areas,or those used in connection with food,beverage, and lodging establishments as defined in law. <br /> www.pca.state.mn.us • 651-296-6300 - 800-657-3864 • TTY 651-282-5332 or 800.657.3864 • Available in alternative formats <br />